Dabigatran as good as aspirin for recurrent stroke prevention in East Asian patients

In preventing recurrent stroke in patients with embolic stroke of undetermined source (ESUS), dabigatran and aspirin are both useful, with the former showing no apparent superiority over the latter, according to data from the RE-SPECT ESUS* trial.

The current analysis included 988 East Asian patients (18 percent) with a recent embolic stroke of undetermined source. They were randomized to receive treatment with either dabigatran (150 or 110 mg twice daily) or aspirin (100 mg once a day).

Recurrent stroke was the primary efficacy outcome, while major bleeding served as the primary safety endpoint. Over a median follow-up of 18.8 months, dabigatran did not outdo aspirin in terms of recurrent stroke (hazard ratio [HR], 0.65, 95 percent confidence interval [CI], 0.41–1.03) or major bleeding (HR, 1.04, 95 percent CI, 0.57–1.91) in East Asian patients.

Meanwhile, death from any cause occurred with greater frequency in the dabigatran versus the aspirin group (HR, 3.98, 95 percent CI, 1.32–12.01).

The clinical construct of ESUS was first introduced in 2014 to define a novel subgroup of cryptogenic stroke with embolic infarction pattern on imaging. Embolism is said to be the likely stroke mechanism in these patients. [Am J Med 2020;133:795-801]

Pooled data from a previous meta-analysis showed that ESUS patients were younger and had lower frequencies of conventional vascular risk factors than non-ESUS patients with ischaemic stroke. ESUS comprises about one in six of ischaemic strokes, and that these relatively young patients with ESUS are at substantial risk of recurrent stroke during antiplatelet therapy. [Stroke 2017;48:867-872]

*Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients With Embolic Stroke of Undetermined Source